Cancer complicates approximately one in a 1000 pregnancies in the United States.
Patients who have cancer and are pregnant need to have their oncologist work with a maternal-fetal medicine specialist who can provide counseling about treatment and offer high-risk pregnancy management.
With advances in oncologic care, more patients are being cured of their disease. Female cancer survivors are increasingly considering pregnancy or conceiving; however, cancer and cancer treatment can have long-lasting effects on a woman’s health.
While the majority of female cancer survivors have a good chance of having a healthy pregnancy, some will experience treatment-related side effects that impact their ability to become pregnant or place them at higher risk for complications during pregnancy.
This Pregnancy and Cancer program was created to help:
- Patients who have become pregnant while undergoing cancer treatment.
- Patients who have been diagnosed with cancer during their pregnancy.
- Patients who have received treatment for cancer and who are now pregnant.
- Patients who would like to become pregnant after receiving cancer treatment.
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Collaborative Approach to Care
Patients do best when they have a collaborative team to help them. At Cleveland Clinic, the team includes the patient’s oncologist, primary care doctor, and subspecialty physician or physicians.
How Maternal-Fetal Medicine Helps
If a patient is pregnant and has active cancer:
- We offer appropriate counseling regarding the pregnancy and treatment options to keep mother and fetus safe
- Partner with Oncology
- We work in partnership with the patient’s oncologist to develop treatment plans and manage side-effects related to cancer treatments.
- We offer appropriate monitoring and management for the pregnancy, including making plans for delivery
If a patient is a cancer survivor and is considering becoming pregnant, we offer:
- Preconception Consultations
- Review of patient’s cancer history and treatment with risk assessment for adverse pregnancy outcomes for mother and fetus
- Pre-conception care
- Referral to a fertility specialist if needed
- Discussion of concerns related to pregnancy’s effect on cancer growth or recurrence
Appointments & Locations
We encourage all patients to work with their oncologist to obtain a referral to this program.
To schedule an appointment with a Cleveland Clinic cancer specialist, call 866.223.8100
To make an appointment with the Ob/Gyn & Women’s Health Institute, call 216.444.6601 (toll-free 800.223.2273 ext. 46601).
Cancer Treatment in Pregnancy
When cancer is found in a mother during pregnancy, it is very important that oncologists (cancer specialists) and obstetricians work together to make sure that both mother and baby get the best possible care. In many cases, your obstetrician may refer you to a maternal-fetal medicine physician, who specializes in management of high-risk pregnancies. Treatment decisions should be made according to the type of cancer, the prognosis, and the gestational age at the time.
Fortunately, it appears pregnancy does not seem the affect the ability of a cancer to grow or spread, and most forms of cancer can be treated during pregnancy without affecting outcome for the mother or the baby. In the majority cases, trying to do best for mother will also lead to the best outcomes for the baby. Unfortunately, the diagnosis of cancer and start of treatment is often delayed during pregnancy. While there are risks to a developing baby with all forms of cancer treatment, surgery, chemotherapy, and in some cases, even radiation therapy can be safely performed during pregnancy.
Surgery is often the first treatment recommended for many types of cancer, and this can be done during pregnancy. The ideal time to perform surgery during pregnancy is the second trimester, especially between weeks 14 and 22, but it can be done earlier or later in pregnancy. There is no evidence to suggest that anesthesia causes miscarriage or birth defects. While there is some increased risk for complications, most mothers and their babies tolerate the procedure well. Formation of blood clots can occur so often patients are placed on a low dose blood thinner following cancer surgery during pregnancy.
Chemotherapy can be safely given during pregnancy. Because these medications can cause birth defects and affect brain development, they are avoided in the early part of pregnancy when the baby’s organs are forming. If patients are early in the pregnancy and treatment cannot be delayed, such as in cases of aggressive leukemia (blood cancers), then pregnancy termination might be recommended. Otherwise, chemotherapy can be started after 14-16 weeks gestational age. For mothers receiving chemotherapy, the same side effects, including hair loss, nausea with vomiting, and suppression of the immune system, can occur, and they should be treated in the same manner as if the patient was not pregnant. For the developing baby, risks from treatment with chemotherapy in the latter part of pregnancy include growth restriction and predisposition to cancer later in life. Otherwise, long term outcomes in children who were exposed to chemotherapy when they were in the womb seem to be good. Discussion regarding these risks with a maternal-fetal medicine specialist is generally recommended prior to starting treatment. Chemotherapy is usually not given for a few weeks prior to term to allow both mother and baby to recover for labor and birth.
Radiation therapy is the least frequently used form of cancer treatment during pregnancy, but it can be used during pregnancy in certain instances. The risks with radiation exposure to a developing baby include miscarriage, birth defects, mental retardation, lagging growth, and development of cancer later in childhood. In general, radiation should be avoided for treating any form of cancer in your abdomen due to high levels of exposure to the fetus; however, it can be given for malignancies involving the chest and brain with steps taken to reduce the dose that the baby is exposed to.
- Cancer and Fertility: Planning for Parenthood after a Cancer Diagnosis
- Cleveland Clinic Fertility Center
- Cancer Center Patient Education and Support
- Ob/Gyn &Women’s Health Patient Education
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